Information Collection

Child Advocate Referral (Form L-12A) - Recordkeepers

IC 271731 under ICR 202410-0970-008 · OMB 0970-0565.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0565 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form L-12A Child Advocate Referral (Form L-12A) - Recordkeepers	Form and Instruction
Form L-12A Child Advocate Referral L-12A Child Advocate Referral_v4_Final Draft - TRANSFERRED & REVISED.pdf	Form and Instruction

IC Title:

Child Advocate Referral (Form L-12A) - Recordkeepers

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 45 CFR § 410.1308 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form L-12A	Child Advocate Referral	L-12A Child Advocate Referral_v4_Final Draft - TRANSFERRED & REVISED.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title: 09-80-0321 ORR Division of Children's Services Records

FR Citation: 81 FR 46682

Number of Respondents: 1

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,601	5,601
Annual IC Time Burden (Hours)	1,848	1,848
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.